A triage centre and a medicine delivery and treatment monitoring service for patients with heart disease/ hypertension/diabetes using the NHS App for the NHS (ISSN 2753-8176 (online))

1. Ana Pedro

1.Gwyntwr1386 Pharmacy, Regus Chester Business Park, Heronsway, Chester, CH49QR, UK.

info@gwyntwr1386.com

The problem

NHS 111

Key problems with the burden it places on emergency and ambulance services. Improvements need to be made to the NHS 111 service to make sure the triage software it uses prioritises patients accurately and minimises inappropriate referrals to the ambulance service. Also, the introduction of the NHS111 online service had a small impact on the number of triaged and total calls. However, evidence suggests an increase in the overall number of disposition recommendations (ambulance, emergency department and primary care) for NHS 111 telephone and online services combined following the introduction of the NHS 111 online service.

Chronic diseases management

There is a high prevalence of diabetes and it continues to increase. The adherence to oral antidiabetics ranges from 36% to 93%. Moreover, improving the adherence to treatment in diabetes patients will lead to a better glycaemic control and could in the long-term reduce the incidence of micro- and macrovascular complications associated with diabetes. Also, most (medicine-compliance aids (MCA) patients are elderly and suffer of combined cardiovascular disease (CV) including diabetes. Moreover, a recent systematic review on the management of medicines for people with cognitive impairment and their carers revealed that this group of patients and their carers need support in the self-management of medicines. Moreover, a recent systematic review on the management of medicines for people with cognitive impairment and their carers revealed that this group of patients and their carers need support in the self-management of medicines. Also, only a few interventions revealed in this study went beyond adherence and lack an approach of the complexity of self-management of medicines and its risks to patients.

The cost of the NHS running with the problem

NHS111

A recent study shows that NHS 111 Online is £67.90 per person cheaper than the NHS 111 telephone service (£39 vs. £106.80).Another study suggests that there could be a cost saving for commissioners of £11,112 if GPs were employed in the call centres, comparing savings made for A&E with GP salary costs in response to inappropriate NHS111 referrals.

Chronic diseases management

Diabetes complications costs the UK healthcare system £6.2 billion a year, what highlights both the seriousness of diabetes as well as the importance of getting the appropriate care to people living with diabetes. Also, hypertension is the number one risk factor for cardiovascular disease, is responsible for around half of all heart attacks and strokes, and has an estimated annual cost to the NHS of over £2 billion. A 2014 Public Health England (PHE) cost-effectiveness review estimated that if England could achieve a 5mmHg reduction in the average population systolic blood pressure over ten years, it could save £850 million and 45,000 quality adjusted life years.

The solution to the problem

NHS111

Set up triage centres for the NHS which would use patient group directions (PGDs) (CAS in Wales and Pharmacist First in England) with clinical pharmacists and the NHS App. The pharmacists would receive calls from patients or chat messages through NHS App and the pharmacists would solve the problem straight away by prescribing or supplying medicines through PGDs, or just advising or would signpost to GP, dentist, opticians, A&E, ambulances, etc according to the seriousness of the situation. If something was prescribed then the pharmacy hubs would send the medicines to the patient. The pharmacy hub would be associated with different GP surgeries in Wales and, in England, the GP surgeries would work as the spokes within the “hub and spoke model” while pharmacies would work as the hub accordingly to new “hub and spoke model” legislation by the UK Government which will be active from January 2025. In Wales, the hub would be a standard pharmacy located within the Health Board Pharmacy department. The triage centers would be based at the pharmacy hubs in England and Wales, so the NHS does not have to include pharmacies in Pharmaceutical lists nor to pay pharmacies to dispense medications but rather hire pharmacies to provide different services. The main users would be the patients and the NHS (GP surgeries, A&E services, ambulances, etc). The patients also would be able to return medication through this system.

Chronic diseases management

Pharmacies would hire clinical pharmacists, with expertise in diabetes or cardiovascular disease medicines optimisation to provide a new, online clinical delivery and treatment monitoring service for the NHS, which will be coupled to the NHS App, based on digital medication adherence packaging (Cpax from Jones Healthcare group in Canada such as blister-packs pill bottles, pre-filled syringes and monitoring POC devices such as the Free Libre Sensor and smart blood pressure monitors. The digital medication adherence packaging will record the time, date and location when a dose is removed or taken and will be coupled with a point of care (POC) continuous monitoring devices such as Free Libre Sensor and smart blood pressure monitors

Cost of this solutions (CIP)

The costs per person of coupling this technology to NHS App and using it for patient triage and monitoring would be of around £39 per person, saving around £67.90 per person in what concerns standard NHS111 usage and saving more than £6 billions on chronic diseases complications management.

Green Carbon Plan/ Net zero carbon benefits

We would expect that the use of the systems and materials suggested in this project, would reduce medicines waste, by controlling patients medication taking and also monitoring their efficacy. Also, would reduce medicines packages waste as these can recycled. Also, would reduce carbon emissions by sending medications to patients home and avoiding their stays in hospitals and reducing patients displacements for appointments.

In this project we will be comparing Net zero carbon benefits between standard services and our proposed services.

References

Impact of NHS 111 Online on the NHS 111 telephone service and urgent care system: a mixed-methods studyHealth Services and Delivery Research, No. 9.21.Turner J, Knowles E, Simpson R, et al.Southampton (UK): NIHR Journals Library; 2021 Nov.

https://www.pulsetoday.co.uk/news/urgent-care/three-quarters-of-nhs-111-referrals-to-ae-are-unnecessary/

https://www.diabetes.org.uk/about-us/news-and-views/cost-complications-highlights-urgent-need-transform-diabetes

https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/articles/riskfactorsforundiagnosedhighbloodpressureinengland/2015to2019#:~:text=High%20blood%20pressure%20(hypertension)%20is,of%20over%20%C2%A32%20billion

Cramer JA: A systematic review of adherence with medications for diabetes. Diabetes Care 2004, 27:1218-1224.

Dailey GE III: Improving oral pharmacologic treatment and management of type 2 diabetes. Manag Care 2004, 13:41-47.

Rozenfeld Y, Hunt JS, Plauschinat C, Wong KS: Oral antidiabetic medication adherence and glycemic control in managed care. Am J Manag Care 2008, 14:71-75

Pedro A. “The use of Multi-compartment Compliance Aids (MCAs) in Pharmacies in England and North Wales”. Preprints. doi 10.20944/preprints202007.0541.v1. July 2020

https://www.freestyle.abbott/uk-en/products/freestyle-libre-2.html

Vervloet et al. BMC Health Services Research 2011, 11:5

Vervloet et al. Int J Med Inform 2012, 594-604

https://www.england.nhs.uk/2021/11/nhs-offers-home-blood-pressure-checks-to-save-thousands-of-lives/

https://www.paramedicpractice.com/content/features/paramedics-perceptions-and-experiences-of-nhs-111-in-the-south-west-of-england/#:~:text=Indeed%2C%20rather%20than%20a%20triage,inappropriate%20or%20delayed%20ambulance%20responses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109810/

https://bmjopen.bmj.com/content/12/7/e058964

Powell et al. (2022). Interventions for self-management of medicines for community-dwelling people with dementia and mild cognitive impairment and their family carers: a systematic review. Age and Ageing, Volume 51, Issue 5https://www.england.nhs.uk/2021/11/nhs-offers-home-blood-pressure-checks-to-save-thousands-of-lives/

https://www.paramedicpractice.com/content/features/paramedics-perceptions-and-experiences-of-nhs-111-in-the-south-west-of-england/#:~:text=Indeed%2C%20rather%20than%20a%20triage,inappropriate%20or%20delayed%20ambulance%20responses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8109810/

https://bmjopen.bmj.com/content/12/7/e058964

Powell et al. (2022). Interventions for self-management of medicines for community-dwelling people with dementia and mild cognitive impairment and their family carers: a systematic review. Age and Ageing, Volume 51, Issue 5